FRIDAY, Oct. 25, 2002 (HealthDayNews) -- It was a small kiosk at an unremarkable American mall, the kind where teenagers go to have their ears pierced quickly and cheaply in between shopping for clothes and CDs.
But in a short period of time in the fall of 2000, seven teens were confirmed to have been infected with the bacterium Pseudomonas aeruginosa. Five of them were hospitalized, five required surgery and three ended up having reconstructive surgery to repair deformities.
"There were seven people we could confirm and probably dozens of others that were infected," says William Keene, the Oregon health official who responded to the initial reports and who will describe the outbreak today at the annual meeting of the Infectious Diseases Society of America (IDSA) in Chicago.
All of the infected teens had had their upper ear cartilage pierced, which is much riskier than having the lobes pierced.
This type of infection appears to be more common following trauma, such as a stab wound, bites or wrestler's injuries, says Dr. Lindhe Guarisco, a pediatric otolaryngologist at the Ochsner Clinic Foundation in New Orleans. The infection is notoriously difficult to treat.
"Once the bacteria is in the cartilage, it's hard to get the antibiotic in there to kill it because there's such bad blood supply," Guarisco says. "I've had cases where I've had to stick catheters under the skin and shoot antibiotics directly under the skin and irrigate it continuously. When this occurs, it's a mess."
The only reason the health department came to know of the outbreak was because two infected teenagers happened to visit the same ear, nose and throat (ENT) specialist -- one of only two in the county -- within a few days of each other. When the doctor realized that both patients had had their ears pierced at the same establishment, he called the health department.
Clusters may be occurring in other parts of the country, but it's unlikely that health officials would ever know about them.
Using sales records, health officials identified and interviewed 121 of 123 people who had had their ears pierced in the previous six weeks. Fifty-three people reported having their upper ear cartilage pierced and, of those, seven had confirmed P. aeruginosa infections. Their ages ranged from 10 to 19. In addition, more than one-third of the 53 people said that the piercing site had drained pus for weeks after the procedure, no doubt indicating additional infections that had healed on their own.
"They weren't life-threatening specifically, but they were pretty serious," Keene says. "Some had permanent disfigurement." These types of infections can cause the ear cartilage to erode so that the outer ear tissue sags and loses it normal shape.
Two things had gone wrong. Firstly, both lobe and cartilage piercings were being done with a spring-loaded "gun," which shoots a stud through the ear tissue. These guns are generally not recommended for cartilage piercing and, in fact, are prohibited for that use in Oregon and several other states.
In addition, one of the workers (who was responsible for six of the confirmed infections) had sprayed the sterile gun with a commercial disinfectant. The bacteria was later found to be growing in both the disinfectant and in the sink. "It's a fine thing to wipe on a countertop," Keene says, but not on an already sterile gun.
"The people who were doing the procedures were not using proper techniques. They were basically just kids. They didn't understand the potential significance of what they were doing," Keene says. "The skin is an important barrier to infection. Most of the time it heals up and it's no big deal, but sometimes things can infect the wound that get ahead of your body's defenses. That's when you get a serious illness. That's what happened to these kids. It's a cautionary tale."
"So many different individuals perform piercing, and to do it right certainly requires some training and some knowledge of infection control procedures," says Dr. Edward Chapnick, director of the infectious disease division at Maimonides Medical Center in Brooklyn, N.Y. "Given the large number of individuals who do this, it's not surprising that there are some who are inadequately trained."
The safest thing is to avoid piercing all together, Keene says. If you do want to go that route, find a licensed store but even that may not be enough: The store in Oregon where the outbreak occurred was licensed.
Don't pierce sites other than the ear lobe, Chapnick advises. Piercing the tongue frequently invites infection. If you must pierce your ear cartilage, make sure it's done with a needle and not a gun.
"I would not encourage my daughters to get piercing through the cartilage. The risk is too high and the treatment [for an infection] is too difficult," Guarisco says. "The ears are going to malform in all of these children."
What To Do
Salisbury University has information on the risks involved in body piercing. Or visit the Association of Professional Piercers.
